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The Global Challenge of Cancer

Posted on by DCPC
Photo of Betsy Kohler, Kathleen Arnold-Lewis, Dr. Mona Saraiya, Dr. Michelle O’Hegarty, and Dr. Hilda Razzaghi.

CDC and the North American Association of Central Cancer Registries (NAACCR) assess medical facilities in St. Croix for cancer case ascertainment. Left to right: Betsy Kohler, NAACCR; Kathleen Arnold-Lewis, U.S. Virgin Islands Department of Health; Dr. Mona Saraiya, CDC; Dr. Michelle O’Hegarty, CDC; Dr. Hilda Razzaghi, CDC

By Hilda Razzaghi

CDC’s Office of International Cancer Control (OICC) is involved in many activities around the world to prevent and control cancer. One important project is to work with the International Agency for Research on Cancer and other organizations to develop regional hubs in low- and middle-income countries to provide localized support, training, and research opportunities to the countries in the region; evaluate and improve existing cancer registries; monitor data quality and disseminate data; and establish cancer registries where none existed. The most recent hub is in the Caribbean region, where cancer is the second leading cause of death. The Caribbean Public Health Agency (CARPHA) in Trinidad and Tobago serves as the hub’s headquarters and provides public health technical support to 24 member states, which include all English- and Dutch-speaking Caribbean countries and Haiti. Understanding cancer control in other countries helps support better systems in both the U.S. and other countries.

I joined the OICC as an Epidemic Intelligence Service officer in July 2015, and my first project was to evaluate CARPHA’s system that tracks cancer deaths. I compared cancer data from 21 CARPHA member states to data from the U.S. Virgin Islands and Puerto Rico for a more complete picture of cancer in the region. We found that in Puerto Rico, the U.S. Virgin Islands, and the Caribbean region, prostate and breast cancers are the leading causes of cancer-related deaths among men and women, respectively. Lung and cervical cancers are also leading causes of death in many Caribbean countries, Puerto Rico, and the U.S. Virgin Islands. The results of this study will provide useful data for establishing the cancer registries in the hub, prioritizing technical assistance in the region, and setting future directions and areas of focus for the hub.

Photo of the Charlotte Kimelman Cancer Institute in St. Thomas.
Charlotte Kimelman Cancer Institute in St. Thomas.

As part of the project, we were invited to help start a cancer registry in the U.S. Virgin Islands. Our week-long visit to the U.S. Virgin Islands included meeting with staff from the Department of Health in St. Croix, the Charlotte Kimelman Cancer Institute in St. Thomas, and representatives from the Puerto Rico Cancer Registry, as well as visiting hospitals, private clinics, and offices that treat cancer patients on both St. Croix and St. Thomas. Through these visits I learned that there were only a few physicians who provided care to cancer patients outside of the hospital in St. Thomas, and many of the patients who were diagnosed with cancer left the islands for treatment due to cultural stigma as well as limited financial resources. In addition, a new mammography facility has been established in St. Croix, where breast cancer screening is being promoted.

My work in the OICC emphasized the applied aspect of epidemiology and public health—different than what I had done before as a researcher. In the last six months, I have seen firsthand some of the challenges that low- and middle-income countries face in starting and maintaining a cancer registry, including registry operations, hiring new and retaining experienced personnel, collecting data most efficiently for small populations in small islands, and patients seeking treatment off the islands. I am looking forward to learning more in the next 18 months of my training to help strengthen cancer surveillance in the U.S. territories and neighboring countries in the region.

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    My advice to patients who are going through the same journey as me is that treatment is best sought early to prevent further complications, as well as to reassure our loved ones of our well-being.

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